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    <div><!----><section><div data-v-bfaee9cc="" id="x-header-container"><div data-v-bfaee9cc="" class="study-top"><div data-v-bfaee9cc="" class="study-top-l"><div data-v-bfaee9cc="" class="diversion-return"><span data-v-bfaee9cc="" href="javascript:;" class="diversion"></span></div><div data-v-bfaee9cc="" class="study-l"><div data-v-bfaee9cc="" class="study-l-t"><h1 data-v-bfaee9cc="" id="show-title"><h1 data-v-bfaee9cc="" title="《中国新生儿转运指南(2013)》解读" class="study-title-h1"> 《中国新生儿转运指南(2013)》解读 </h1><span data-v-bfaee9cc="" class="study-title-span"><span title="期刊" class="mytype">（期刊）</span><a href="https://kns.cnki.net/knavi/journals/FYYD/detail?uniplatform=NZKPT" title="发育医学电子杂志" target="_blank">发育医学电子杂志</a><span class="vm">2013(02)</span></span></h1><a data-v-bfaee9cc="" target="_blank" class="details icon-common js-details hide" href="https://kns.cnki.net/kcms2/article/abstract?v=ZODoBDhYdpfMZVHAqtxALT_UmAYJvTYrMqZEdj3guKkEbxAlH0clQNWTCnGaL5tjmwJh5ZY1hSke1rOIkyZzEUKQ6d01-uWXn-yjvRJdmqC7cme0jTMiSNYdDzlsHCEEBgnuSmhA7HK1pTUUN9aTLbkc3v9_sagdyrRIIpaq2imHVG-ztH23ZCIwYjx1IrLhCbA62NrYad4=&amp;uniplatform=NZKPT&amp;language=CHS"><span data-v-bfaee9cc="" class="iconfont icon-Bibliography-Fill"></span><span data-v-bfaee9cc="" class="tip-title">文献详情</span></a></div></div></div><div data-v-bfaee9cc="" class="study-top-r"><div data-v-bfaee9cc="" class="img-user"><img data-v-bfaee9cc="" src=""><span data-v-bfaee9cc="" class="user-html">欢迎<span style="display:inline-block;margin:2px;font-weight: bold;">浙江大学图书馆</span></span></div></div></div></div><main class="main-container trial-main-container"><div class="m-catalog ani-duration" style="margin-left: 0px;"><div class="catalog-title"><span class="catalog-tab active"> 目录 </span><!----><!----><span id="js-tabBtn-l" class="catalog-tab-close"><i class="iconfont icon-NO"></i><span class="catalog-btn-close js-catalog-btn-close" style="display: none;"> 目录 </span></span></div><div class="catalog-content"><ul id="js-catalog-tree" class="ztree ztree-fbg" style="top: 30px;"><li id="js-catalog-tree_1" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_1_switch" title="" class="button level0 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_1_a" class="level0" treenode_a="" target="_blank" style="" title="一、关于建立区域性新生儿转运网络(Regional neonatal transport network,RNTN)"><span id="js-catalog-tree_1_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_1_span" class="node_name">一、关于建立区域性新生儿转运网络(Regional neonatal transport network,RNTN)</span></a></li><li id="js-catalog-tree_2" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_2_switch" title="" class="button level0 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_2_a" class="level0" treenode_a="" target="_blank" style="" title="二、关于RNTN组织活动"><span id="js-catalog-tree_2_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_2_span" class="node_name">二、关于RNTN组织活动</span></a></li><li id="js-catalog-tree_3" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_3_switch" title="" class="button level0 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_3_a" class="level0" treenode_a="" target="_blank" style="" title="三、RNTN的转运模式"><span id="js-catalog-tree_3_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_3_span" class="node_name">三、RNTN的转运模式</span></a></li><li id="js-catalog-tree_4" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_4_switch" title="" class="button level0 switch noline_open" treenode_switch=""></span><a id="js-catalog-tree_4_a" class="level0" treenode_a="" target="_blank" style="" title="四、RNTN的业务管理"><span id="js-catalog-tree_4_ico" title="" treenode_ico="" class="button ico_open" style=""></span><span id="js-catalog-tree_4_span" class="node_name">四、RNTN的业务管理</span></a><ul id="js-catalog-tree_4_ul" class="level0 " style=""><li id="js-catalog-tree_5" class="level1" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_5_switch" title="" class="button level1 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_5_a" class="level1" treenode_a="" target="_blank" style="" title="1. 管理制度:"><span id="js-catalog-tree_5_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_5_span" class="node_name">1. 管理制度:</span></a></li><li id="js-catalog-tree_6" class="level1" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_6_switch" title="" class="button level1 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_6_a" class="level1" treenode_a="" target="_blank" style="" title="2. 关于转运指征:"><span id="js-catalog-tree_6_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_6_span" class="node_name">2. 关于转运指征:</span></a></li><li id="js-catalog-tree_7" class="level1" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_7_switch" title="" class="button level1 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_7_a" class="level1" treenode_a="" target="_blank" style="" title="3. 积极开展宫内转运:"><span id="js-catalog-tree_7_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_7_span" class="node_name">3. 积极开展宫内转运:</span></a></li><li id="js-catalog-tree_8" class="level1" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_8_switch" title="" class="button level1 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_8_a" class="level1" treenode_a="" target="_blank" style="" title="4. 知情同意:"><span id="js-catalog-tree_8_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_8_span" class="node_name">4. 知情同意:</span></a></li></ul></li><li id="js-catalog-tree_9" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_9_switch" title="" class="button level0 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_9_a" class="level0" treenode_a="" target="_blank" style="" title="五、转运队伍"><span id="js-catalog-tree_9_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_9_span" class="node_name">五、转运队伍</span></a></li><li id="js-catalog-tree_10" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_10_switch" title="" class="button level0 switch noline_open" treenode_switch=""></span><a id="js-catalog-tree_10_a" class="level0" treenode_a="" target="_blank" style="" title="六、转运的实施"><span id="js-catalog-tree_10_ico" title="" treenode_ico="" class="button ico_open" style=""></span><span id="js-catalog-tree_10_span" class="node_name">六、转运的实施</span></a><ul id="js-catalog-tree_10_ul" class="level0 " style=""><li id="js-catalog-tree_11" class="level1" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_11_switch" title="" class="button level1 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_11_a" class="level1 curSelectedNode" treenode_a="" target="_blank" style="" title="1. 转运前准备:"><span id="js-catalog-tree_11_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_11_span" class="node_name">1. 转运前准备:</span></a></li><li id="js-catalog-tree_12" class="level1" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_12_switch" title="" class="button level1 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_12_a" class="level1" treenode_a="" target="_blank" style="" title="2. 转运途中处理:"><span id="js-catalog-tree_12_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_12_span" class="node_name">2. 转运途中处理:</span></a></li><li id="js-catalog-tree_13" class="level1" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_13_switch" title="" class="button level1 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_13_a" class="level1" treenode_a="" target="_blank" style="" title="3. 转运结束后的工作:"><span id="js-catalog-tree_13_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_13_span" class="node_name">3. 转运结束后的工作:</span></a></li></ul></li><li id="js-catalog-tree_14" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_14_switch" title="" class="button level0 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_14_a" class="level0" treenode_a="" target="_blank" style="" title="七、转运的评估与质控"><span id="js-catalog-tree_14_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_14_span" class="node_name">七、转运的评估与质控</span></a></li><li id="js-catalog-tree_15" class="level0" tabindex="0" hidefocus="true" treenode=""><span id="js-catalog-tree_15_switch" title="" class="button level0 switch noline_docu" treenode_switch=""></span><a id="js-catalog-tree_15_a" class="level0" treenode_a="" target="_blank" style="" title="参考文献"><span id="js-catalog-tree_15_ico" title="" treenode_ico="" class="button ico_docu" style=""></span><span id="js-catalog-tree_15_span" class="node_name">参考文献</span></a></li></ul><!----><ul class="catalog-content-table" style="display: none;"></ul></div><a class="drag-btn"></a><span class="catalog-switch" style="display: none;"> 目录 </span></div><div data-v-f43302fc="" class="study-right study-right-trial right-hide ani-duration"><div data-v-f43302fc="" class="stu-navs"><ul data-v-f43302fc="" class="navs-top"><li data-v-f43302fc="" dd="tab-refer" class="nav-btn ckwx"><span data-v-f43302fc="">参考文献</span></li><li data-v-f43302fc="" dd="tab-footnote" class="nav-btn fnzs two-word"><span data-v-f43302fc="">注释</span></li></ul></div><div data-v-f43302fc="" class="stu-content" style="display: none;"><div data-v-f43302fc="" class="c-box js-right-container"><span data-v-f43302fc="" class="iconfont close-right icon-NO"></span><div data-v-9a152a82="" data-v-f43302fc="" class="Refer" style="display: none;"><div data-v-4156a3f9="" data-v-9a152a82="" class="ReferenceToobar"><div data-v-4156a3f9=""><div data-v-4156a3f9="" class="ReferenceToobar-item ReferenceToobar-cur"> 参考文献(22) </div></div></div><div data-v-10a8fdb6="" data-v-9a152a82="" class="h-hide pl16"><ul data-v-10a8fdb6="" class="note-list  refrence-list js-list-refrence mr8"><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="29" href="javascript:void(0)"><span data-v-10a8fdb6="">[1]封志纯.高危新生儿的转运.中国儿童保健杂志,2008,16:5-8.</span></a></span></li><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="31" href="javascript:void(0)"><span data-v-10a8fdb6="">[2]孔祥永,高昕,尹晓娟,等.区域性综合主动型新生儿转运网络组织的应用研究.中华儿科杂志,2010,48:4-8.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="33" href="javascript:void(0)"><span data-v-10a8fdb6="">[3]Lee SK,McMillm DD,Ohlsson A,et al.Variations in Practice and Outcomes in the Canadian NICU Network:1996-1997.Pediatrics,2000,106:1070-1079.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="35" href="javascript:void(0)"><span data-v-10a8fdb6="">[4]Lui K,Ahdel-Latif ME,Allgood CL,et al.Improved outcomes of extremely premature outborn infants:effects of strategic changes in perinatal and retrieval services.Pediatrics,2006,118:2076-2083.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="37" href="javascript:void(0)"><span data-v-10a8fdb6="">[5]Chien LY,Whyte R,Aziz K,et al.Improved outcome of preterm infants when delivered in tertiary care centers.Obstet Gynecol,2001,98:247-252.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="39" href="javascript:void(0)"><span data-v-10a8fdb6="">[6]Neto MT.Regionalization,networks and neonatal transport.J Matern Fetal Neonatal Med,2002,11:140.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="41" href="javascript:void(0)"><span data-v-10a8fdb6="">[7]Fenton AC,Leslie A,Skeoch CH.Optimising neonatal transfer.Arch Dis Child Fetal Neonatal Ed,2004,89:F215-219.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="43" href="javascript:void(0)"><span data-v-10a8fdb6="">[8]Fenton AC,Leslie A.The state of neonatal transport services in the UK.Arch Dis Child Fetal Neonatal Ed,2012,97:F477-481</span></a></span></li><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="45" href="javascript:void(0)"><span data-v-10a8fdb6="">[9]封志纯,王斌,黄为民,等.区域性新生儿转运网络几种模式比较.中华围产医学杂志,2000,3:127-128.</span></a></span></li><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="47" href="javascript:void(0)"><span data-v-10a8fdb6="">[10]张雪峰,李瑛,肖桂华,等.区域内危重新生儿转运体系的应用研究.中国当代儿科杂志,2012,14:101-104.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="49" href="javascript:void(0)"><span data-v-10a8fdb6="">[11]Skeoch CH,Jackson L,Wilson AM,et al.Fit to fly:practical challenges in neonatal transfers by air.Arch Dis Child Fetal Neonatal Ed,2005,90:F456-460.</span></a></span></li><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="51" href="javascript:void(0)"><span data-v-10a8fdb6="">[12]陈运彬,张小庄,帅春杨,等.区域性危重新生儿转运系统运作10年的远期效果随访中国妇幼保健,2005,20:908-910.</span></a></span></li><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="53" href="javascript:void(0)"><span data-v-10a8fdb6="">[13]封志纯,王斌,黄为民,等.珠江三角洲新生儿转运网络10年工作及效果报告.中国儿童保健杂志,2000,8:8-10.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="55" href="javascript:void(0)"><span data-v-10a8fdb6="">[14]Hohlagschwandtner M,Husslein P,Klebermass K,et al.Perinatal mortality and morbidity comparison between maternal transport,neonatal transport and inpatient antenatal treatment.Arch Gynecol Obset,2001,265:113-118.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="57" href="javascript:void(0)"><span data-v-10a8fdb6="">[15]Kempley ST,Baki Y,Hayter G,et al.Effect of a centralised transfer service on characteristics of interhospital neonatal transfers.Arch Dis Child Fetal Neonatal Ed,2007,92:F185-188.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="59" href="javascript:void(0)"><span data-v-10a8fdb6="">[16]King BR,King TM,Foster RL,et al.Pediatric and neonatal transport teams with and without a physician:a comparison of outcomes and interventions.Pediatr Emerg Care,2007,23:77-82.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="61" href="javascript:void(0)"><span data-v-10a8fdb6="">[17]Moss SJ,Embleton ND,Fenton AC.Towards safer neonatal transfer:the importance of critical incident review.Arch Dis Child,2005,90:729-732.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="63" href="javascript:void(0)"><span data-v-10a8fdb6="">[18]Kempley ST,Sinha AK,Thames Regional Perinatal Group.Census of neonatal transfers in London and the South East of England.Arch Dis Child Fetal Neonatal Ed,2004,89:F521-526.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="65" href="javascript:void(0)"><span data-v-10a8fdb6="">[19]De Vries S,Wallis LA,Maritz D.A retrospective evaluation of the impact of a dedicated obstetric and neonatal transport service on transport times within an urban setting.Int J Emerg Med,2011,4:28.</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="67" href="javascript:void(0)"><span data-v-10a8fdb6="">[20]Spector JM,Villanueva HS,Brito ME,et al.Improving outcomes of transported newborns in Panama:impact of a nationwide neonatal provider education program.J Perinatol,2009,29:512-516.</span></a></span></li><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="69" href="javascript:void(0)"><span data-v-10a8fdb6="">[21]谢婉花,周伟,陈文琼.213例机械通气新生儿院间转运的管理.中华围产医学杂志,2010,13:107-109</span></a></span></li><li data-v-10a8fdb6="" title="该篇文献未被CNKI收录" class="disable"><span data-v-10a8fdb6="" class=""><a data-v-10a8fdb6="" id="71" href="javascript:void(0)"><span data-v-10a8fdb6="">[22]Retnavel N.Safety and governance issues for neonatal transport services.Early Hum Dev,2009,85:483-486.</span></a></span></li></ul></div></div><!----></div></div><div data-v-f43302fc="" class="drag-btn"></div></div><div id="study-cen" oncopy="return false;" class="study-main js-study-main body-container"><div class="art-hide"><div id="ChapterContainerWrap" class="ChapterContainerWrap"><!----><p class="fail-text">  </p><div data-v-a6ae5f94=""><div data-v-a6ae5f94="" class="el-dialog__wrapper" style="display: none;"><div role="dialog" aria-modal="true" aria-label="dialog" class="el-dialog el-dialog--center dialogue dialogue-copy" style="margin-top: 15vh; width: 480px;"><div class="el-dialog__header"><span class="el-dialog__title"></span><button type="button" aria-label="Close" class="el-dialog__headerbtn"><i class="el-dialog__close el-icon el-icon-close"></i></button></div><!----><!----></div></div><!----><div data-v-a6ae5f94="" class="js-dictionary dictionary-container hide"><div class="other-result">查询中，请稍候......</div></div><div data-v-a6ae5f94="" class="js-refrence refrence-container hide"><div><!----><div><div class="refrence-middle refrence-middle-notilu paddingTop0">  </div></div></div></div><!----><!----><!----><div data-v-a6ae5f94="" class="m-toolbar 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href="https://kns.cnki.net/kcms2/author/detail?v=ZODoBDhYdpcRZxtlOV08yjH1JU_VsBqPZJHYJ_D9Jz9XYA-g4RdoJS8Fw_v_KGhRgIq-vhWfsn9IwF44rBTvkOETxaSkOv1H2RzgGiAUPzI8G4yB62CfbiUxFtfF9stS&amp;uniplatform=NZKPT&amp;language=CHS" target="_blank" class="name-link"><span>孔祥永</span></a><span>，</span></li><li><a href="https://kns.cnki.net/kcms2/author/detail?v=ZODoBDhYdpcRZxtlOV08yjH1JU_VsBqP8IpwvdTBPJW4o1LUZjx1tzanVbEo3Irzs2HeFymQGcA3IGsZp_GOqX2RbguUiRKuWU4CLrxmRxaYpymkbQMrHyCgxb6SCa-C&amp;uniplatform=NZKPT&amp;language=CHS" target="_blank" class="name-link"><span>封志纯</span></a><!----></li></ul><ul id="1000002" role="para" class="Chapter-people"><li><a href="https://kns.cnki.net/kcms2/organ/detail?v=ZODoBDhYdpcRZxtlOV08ypN9HV3iKdQbVWGsqEd6-lXCycdX_aEyjkc-PCtuTB3mzalqSWzPbjK0CYTPjaQTNzdB_iDWj7PmGYlKar-cIEfio3mSn7mCY8K32FzUIM1pxkmaSkHaBPUlpnAU0EAVmCzdgR1IkLZzuT3TrLG0MM6Dgow7ys-BfICxf6FyrlM7jo0DcYYOE_ui2Kg6EX9J2weuVEPrJTMQmHKUjT94p2HuyJTmfPDudiv5gMmeTapBN4EwGWLnb-ATOfVSuQlXM92MLEF3DSgR7uMUaxljid4bS_eF9hAwK2ePHcsMLCSzsKY5ElxhUE4=&amp;uniplatform=NZKPT&amp;language=CHS" target="_blank" class="name-link"><span>北京军区总医院附属八一儿童医院新生儿中心</span></a><!----></li></ul></div><div class="ChapterP-wrap"><!----><!----><div data-id="16dbe71f-c678-11e6-a53d-005056ad2014" class="ChapterWrap ChapterP"><div id="1000007" role="para" data-id="16dbe71f-c678-11e6-a53d-005056ad2014-P1000007"><p data-id="16dbe71f-c678-11e6-a53d-005056ad2014-P1000007-Pundefined" class="ovhide"><span class="b font-bold">关键词：</span><span><a href="https://kns.cnki.net/kcms2/keyword/detail?v=ZODoBDhYdpcRZxtlOV08ykm66nEorxZvVl7qDqhapSNM5VU6ySVDhwY0hIH5nRtl0OJuZeShpVS694KVKd_trdzUURo5sVNk5m1S1zEJ_hPxIl21hWALoKmb28uqD_BW&amp;uniplatform=NZKPT&amp;language=CHS" target="_blank" class="name-link">新生儿转运</a><span>;</span></span><span><a href="https://kns.cnki.net/kcms2/keyword/detail?v=ZODoBDhYdpcRZxtlOV08ykm66nEorxZvqQ5ANDpuz3PhjqRmiemS8hFADqMdowGk92qpYTq9l6iLuQdko8ze4s7cXbUKdT1V6OtVpYYcFlo=&amp;uniplatform=NZKPT&amp;language=CHS" target="_blank" class="name-link">区域性</a><span>;</span></span><span><a href="https://kns.cnki.net/kcms2/keyword/detail?v=ZODoBDhYdpcRZxtlOV08ykm66nEorxZveG6QdkcihwSvIaMQ9-o5vIXxK6wxd_krkMPu9e-Qm1lMCOYivGiIQdlcSDtLlECyg7vbyAbiWA9cULD6zmkn43_skeKRpulgSteBh5ZsV6qJZJTvy4mLG0AnvoiqYYcBRdjk6CL-QE4jxfS2P22GaivZcVfB8IJNMSW3XXhavfzoUWQOKmE93Q==&amp;uniplatform=NZKPT&amp;language=CHS" target="_blank" class="name-link">《中国新生儿转运指南(2013)》</a><!----></span></p></div></div><div id="1000008" class="ChapterWrap ChapterP"><p data-id="undefined-Pundefined" class="ovhide"><span class="b font-bold">作者简介：</span><span>封志纯,E-mail:zhjfengzc@126.com</span></p></div><div id="1000009" data-id="0d80088b-c678-11e6-a53d-005056ad2014" class="ChapterWrap ChapterP"><p data-id="0d80088b-c678-11e6-a53d-005056ad2014-Pundefined" class="ovhide"><span class="b font-bold">收稿日期：</span><span>2013-3-12</span></p></div></div><div class="render-en"><!----><div class="ChapterWrap ChapterMsg"><!----><!----></div><!----></div><div data-id="CJFD|FYYD201302002_3b195017" class="ChapterWrap Content"><p id="1" anchor="" data-id="CJFD|FYYD201302002_3b195017-P1">20世纪80年代后期和90年代初,随着国内新生儿重症监护病房(neonatal intensive care unit,NICU)的建立,我国的新生儿转运(neonatal transport)工作也逐步得到开展,近十几年来发展迅速,目前我国许多大中城市均开展了新生儿转运工作,且转运规模不断扩大,转运技术不断完善和提高。但是,我国的新生儿转运工作相对于发达国家起步较晚,转运体系尚未完善。为进一步规范和优化新生儿转运工作,使新生儿医护人员对新生儿转运有较为正确的认识,中国医师协会新生儿专业委员会组织相关新生儿科专家,依据国内外近年来的临床实践和研究进展,制定了《中国新生儿转运指南》。现将“指南”中的相关内容作一解读。</p></div><div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h1_1"><h1 class="Chapter" data-id="CJFD|FYYD201302002_h1_1-H">一、关于建立区域性新生儿转运网络(Regional neonatal transport network,RNTN)</h1><p id="3" anchor="" data-id="CJFD|FYYD201302002_h1_1-P3">区域性的RNTN是指以Ⅲ级NICU为转运中心,向周围辐射,集现场急救、转运、通讯和培训为一体的特殊医疗服务系统,主要通过有计划、有组织的对基层医院中的危重新生儿进行就地抢救,待病情稳定后再转运至高级NICU,使危重患儿得到更好的诊疗和监护,从而降低新生儿病死率和致残率<sup id="73" type="reference" href="29,31" rel="bibliography">[1-2]</sup>。新生儿转运已成为新生儿重症救护工作中的重要内容,发达国家较早建立的区域性危重新生儿转运系统已证明对保障母婴健康至关重要<sup id="74" type="reference" href="33,35,37" rel="bibliography">[3-5]</sup>。尽管发达国家的新生儿转运系统都已十分完善,但我国现阶段的社会经济物质基础条件和文化背景与之都有较大差异,所以全盘照搬西方危重新生儿转运模式在我国大部分地区难以实行。因此,结合我国以及本地区的实际情况,进一步规范RNTN的组织、内容和方法,建立我国现阶段较适宜的网络模式是非常必要的。由于NICU需要投入大量的资金和人力,如果每家医院均设立NICU,会因为床位使用率较低而造成卫生资源的浪费,所以应设立区域性的转运中心<sup id="75" type="reference" href="39" rel="bibliography">[6]</sup>。转运中心的服务范围要综合考虑地理形态、人口密度、气候条件、人情习俗、区域经济和可提供适当服务的NICU数量等因素。范围过小可导致卫生资源的浪费,范围过大可能导致转运中心超负荷运转<sup id="76" type="reference" href="41,43" rel="bibliography">[7-8]</sup>。再者,目前条件下,由于转运工具仍以救护车为主,所以RNTN所服务的区域还应避免因路途遥远、转运时间过长而增加转运风险,更应避免舍近求远的现象。指南中还指出,转运中心的等级认定不是依据所在医疗保健单位的行政层次或等级,而是完全依据NICU的救治技术层次,即参考中国医师协会新生儿专业委员会发布的《中国新生儿病房分级建设和管理指南(建议案)》建立的三个不同等级的Ⅲ级新生儿病房,即a、b、c等NICU。Ⅲ级NICU是RNTN的核心基地,其规模、设施、人员、技术的层次和质量水平决定RNTN工作的层次和质量水平。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h1_2"><h1 class="Chapter" data-id="CJFD|FYYD201302002_h1_2-H">二、关于RNTN组织活动</h1><p id="5" anchor="" data-id="CJFD|FYYD201302002_h1_2-P5">目前,国内多数地区的RNTN的活动还依赖于区域性卫生行政部门的行政文件或命令,这种指令性RNTN由于行政命令的权威性,虽然便于组织和维持,但NICU的救治技术和管理水平并非与现有医疗保健单位的级别相吻合,NICU层次的提高也并非完全取决于行政干预和资金投入,尚有人才、管理等多种因素作用,不一定满足人们对提高医疗服务质量的要求。目前单纯依赖行政命令的危重新生儿转运,在巩固和发展方面所表现出来的问题越来越明显,主要表现为缺少发展的压力和动力。所以,RNTN内各级医疗单位没必要存在行政区域的上、下级管辖关系,可以不必受行政命令的约束,其组成和活动应依靠基层单位对作为各级转运中心的NICU所提供的优良救治技术和服务质量的认同,其维系力量完全依赖于转运中心的技术权威性及其对基层单位的业务支持,这种组织类型被称为功能性组织。其优点是RNTN的凝聚力来源与提高救治水平总目标是一致的,竞争的压力可以转化为发展的动力,且适应医疗保健体制改革的大趋势,还可以通过学术、技术的纽带起到强化网络组织的作用,有利于促进转运网络工作的不断进步<sup id="77" type="reference" href="29" rel="bibliography">[1]</sup>。而且随着市场经济的发展,人们按意愿选择就医的自主性必将更强,所以RNTN的建立应打破部门、地区辖属关系的界限,行政命令与功能选择相结合,这样更有利于组建高质、高效、符合国情的转运网络。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h1_3"><h1 class="Chapter" data-id="CJFD|FYYD201302002_h1_3-H">三、RNTN的转运模式</h1><p id="7" anchor="" data-id="CJFD|FYYD201302002_h1_3-P7">医院间的新生儿转运的发展共经历了三种模式:(1)通过本院的急诊医疗服务转运。(2)通过当地急救站急救车及其医护人员转运。(3)通过专业的新生儿专业医护人员转运。前两种转运模式。起源于转诊医院,被称为单向转运。表面上看,这种模式简单易行,但单向转运却有着很多缺点。许多急诊医疗服务救护车并没有足够的新生儿急救或复苏所需的装备,负责转运的人员一般不具备新生儿专业知识和技能,不能对危重症新生儿提供初步救治,也不能处理或预防在转运途中病情的恶化。通过新生儿专业医护人员主动转运,可以解决单向转运所带来的诸多问题,即由接受单位派来的专业医疗队伍接回患儿,主动将“流动的NICU”送到危重患儿身边的转运服务系统,转运服务范围包括产房待产、新生儿转运和宫内转运在内的全方位服务。国内部分地区新生儿转运经过近20年的实践,已经形成了以主动转运、全过程及全方位服务,陆空途径结合为特征的综合主动型转运服务模式,也已证明这种区域性的综合主动型RNTN模式是适应目前我国国情的最优化RNTN模式<sup id="78" type="reference" href="47" rel="bibliography">[2,9-10]</sup>。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h1_4"><h1 class="Chapter" data-id="CJFD|FYYD201302002_h1_4-H">四、RNTN的业务管理</h1><p id="9" anchor="" data-id="CJFD|FYYD201302002_h1_4-P9">危重新生儿转运是转运单位、现场单位和患儿家庭多方参与的常备性工作,因此转运组织与管理工作和转运单位的监护救治能力、转运过程的监护救治能力一样,是危重新生儿转运工作成败的保障因素之一。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h2_1"><h2 class="Chapter" data-id="CJFD|FYYD201302002_h2_1-H">1. 管理制度:</h2><p id="11" anchor="" data-id="CJFD|FYYD201302002_h2_1-P11">RNTN具有服务面广、工作量大、应急性强和技术精细的特点,要求转运单位:(1)装备精良,具备高速移动中监护救治新生儿的高超技术条件。(2)运筹周密,保证安全和快速的效果<sup id="79" type="reference" href="29" rel="bibliography">[1]</sup>。完善的管理体系是顺利完成危重新生儿转运工作的保障因素之一。发达国家和地区将危重救护转运系统归入军队体系。主要是因为军队卫勤学的伤病员紧急救护运送技术体系素以装备优良、技术过硬、服务精心、制度严明、反应快速为特征,是包括新生儿转运在内的所有急救转运系统的最佳运作体系<sup id="80" type="reference" href="29,49" rel="bibliography">[1,11]</sup>。因此,转运单位的组织管理工作有必要遵从军队卫生勤务学的原理和要求进行。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h2_2"><h2 class="Chapter" data-id="CJFD|FYYD201302002_h2_2-H">2. 关于转运指征:</h2><p id="13" anchor="" data-id="CJFD|FYYD201302002_h2_2-P13">RNTN的建立与完善,制定合理、标准化的转运指征实属必要,但目前条件下,我国各省市、地区以及基层医院的NICU的设备、技术力量差异较大,较难在全国范围内建立统一的不同级别的RNTN转运指征。实际上,即使制订了较统一的转运指征,也往往因为部分上级转运中心实际救治危重新生儿的能力不足,而将患儿转运到距离较远的能胜任的NICU,增加了转运风险。各地经验表明,危重新生儿转运成功与否与基层医院对危重新生儿转运时机的掌握明显相关,是否能及时修正所制定的转运指征<sup id="81" type="reference" href="31,47,51" rel="bibliography">[2,10,12]</sup>。各地、各级RNTN应以《中国新生儿病房分级建设和管理指南(建议案)》定义的各等级NICU的业务范围为依据,即按照初级、高级和特级转运中心的救治能力分别制定相应的转运指征逐级转运,既能够实现优质卫生资源的充分利用,又可以防止转运中心超负荷运转,指征过严或过宽均不利于患儿的救治。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h2_3"><h2 class="Chapter" data-id="CJFD|FYYD201302002_h2_3-H">3. 积极开展宫内转运:</h2><p id="15" anchor="" data-id="CJFD|FYYD201302002_h2_3-P15">所谓宫内转运是指将高危产妇在分娩前转运至III级NICU中心进行分娩,具有高危妊娠因素的孕妇应宫内转运至上级转运中心进行分娩。国内外实践均证明,宫内转运是一种最安全和便利的转运方式,能够使母亲和新生儿均得到及时有效的救治,是降低孕产妇和新生儿死亡率最理想的方式,是目前转运的新趋势<sup id="82" type="reference" href="35,55" rel="bibliography">[4-5,13-14]</sup>。但由于各种原因,国内开展宫内转运的工作并不普遍,其原因在于有些高危因素往往在妊娠期难以预测或直至分娩时才出现,某些孕妇并不能做到规律产前检查。因此,如果未能进行宫内转运,当高危产妇分娩或早产时转运队伍可提前到达现场,及时参与复苏抢救,可以达到与宫内转运同样的效果。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h2_4"><h2 class="Chapter" data-id="CJFD|FYYD201302002_h2_4-H">4. 知情同意:</h2><p id="17" anchor="" data-id="CJFD|FYYD201302002_h2_4-P17">近年医疗纠纷逐年增加,所以医患之间的沟通和转运医院间的沟通至关重要。向患儿家长详细解释患儿病情、转运的原因和风险等问题,取得家长的理解与合作是成功转运的基础。患儿家长的知情同意、医院之间病史资料的一致是减少医疗纠纷或在医疗纠纷中取得主动的关键。目前我国尚无统一规格的转诊同意书及转运情况介绍,各级RNTN的管理者应组织医护人员结合当地实际制定,最好请法律专家参与审定,有助于规避这方面的风险。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h1_5"><h1 class="Chapter" data-id="CJFD|FYYD201302002_h1_5-H">五、转运队伍</h1><p id="19" anchor="" data-id="CJFD|FYYD201302002_h1_5-P19">许多研究均证明,专业的新生儿转运队伍精通转运医疗并在新生儿急救医学方面经过专业的训练,而且他们也具有充分的准备和新生儿急救或复苏所需的专业化的设备,从而降低转运风险<sup id="83" type="reference" href="29,35,53,57" rel="bibliography">[1,4,13,15]</sup>。从广义上讲,转运队伍应包括转运管理人员和转运医护人员。前者是危重新生儿转运的后勤保障,而后者则是直接参与转运,不仅是转运的执行者,而且是组织者和决策者,在转运工作中起主导作用。转运小组中至少包括一名新生儿科医师和护士,设立多个转运小组以保证转运工作的及时和顺利完成也是必须的。在英国也有单纯由注册护士参与危重新生儿转运的报道,其效果与有医生参与相比预后无明显差别,反而更加缩短了转运时间,而北美和澳大利亚等国家新生儿转运则要求必须有新生儿科医生参与<sup id="84" type="reference" href="59,61" rel="bibliography">[16-17]</sup>。因此,对转运队伍的组成似乎还需要实践进一步证明。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h1_6"><h1 class="Chapter" data-id="CJFD|FYYD201302002_h1_6-H">六、转运的实施</h1></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h2_5"><h2 class="Chapter" data-id="CJFD|FYYD201302002_h2_5-H">1. 转运前准备:</h2><p id="22" anchor="" data-id="CJFD|FYYD201302002_h2_5-P22">新生儿病情发展迅速,疾病危重,且常常导致严重后遗症。国内外研究发现,凡在生后尽早转运的新生儿救治顺利、效果较好,新生儿转运前的处理直接关系到患儿的生命及其后的生存质量,应该争分夺秒<sup id="85" type="reference" href="51,53,55" rel="bibliography">[12-14]</sup>。准备过程主要包括两个阶段:(1)转运队伍到达之前转出医院的处理。(2)转运队伍到达后的处理。这两个阶段的主要任务均是对患儿进行必要的复苏,密切监护,尽可能的稳定患儿病情,能够完成转运。转运前准备所需时间,即稳定时间,是指从抵达转出医院到离开的时间,其受到患儿病情严重程度和必须采取的医疗措施次数的影响。但应尽量避免稳定时间过长,因为目前尚无证据表明其可改善患儿的预后<sup id="86" type="reference" href="63,65" rel="bibliography">[18-19]</sup>。病情稳定的标准运用STABLE(sugar,temperature,assisted breathing,blood pressure,lahwork,emotional support)技术及临床症状等作为评价指标。在STABLE模式下,新生儿转运是一种预见性的转运,在了解患儿生命体征,给予生命支持的同时,还考虑到患儿的预后问题,并在转运的开始就采取措施来预防后遗症的发生<sup id="87" type="reference" href="29,67" rel="bibliography">[1,20]</sup>。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h2_6"><h2 class="Chapter" data-id="CJFD|FYYD201302002_h2_6-H">2. 转运途中处理:</h2><p id="24" anchor="" data-id="CJFD|FYYD201302002_h2_6-P24">转运过程中应尽量保持重症监护的连续性,转运期间的监测治疗水平应确保患儿的生命安全,尽可能使患儿得到相当于NICU的医疗护理,力争做到转运前后监测治疗的无缝衔接。监护的重点是生命体征,这对于保障危重新生儿的生命、阻止病情恶化起着重要作用。随着转运的不断发展,转运设备也不断完善,途中监护水平不断提高。但转运医护人员绝不能掉以轻心,由于路途颠簸,各种仪器设备受干扰严重,尤其是报警设备常出现假报警或不报警等情况,因此即使具备各种先进设备,转运途中医护人员仍应定时查看患儿,确保转运途中万无一失<sup id="88" type="reference" href="69" rel="bibliography">[21]</sup>。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h2_7"><h2 class="Chapter" data-id="CJFD|FYYD201302002_h2_7-H">3. 转运结束后的工作:</h2><p id="26" anchor="" data-id="CJFD|FYYD201302002_h2_7-P26">要重视转运后的反馈工作,加强与转诊医院之间和网络之间交流,对整个网络的发展和新生儿综合救治水平的提高有重要意义。NICU是危重新生儿转运网络中最关键的环节,各级NICU是危重患儿后续治疗的保障。绿色通道的建立可以密切转运中心与网络医院的关系,促进沟通与合作,共同提高急救水平,使转运中心成为他们可以信赖的基地和坚强后盾。转运中心规模、设备、技术实力以及科学规范管理均起到强化转运网络组织的作用,对提高危重新生儿的救治水平、降低新生儿死亡率起关键性作用<sup id="89" type="reference" href="31" rel="bibliography">[2]</sup>。</p></div><div class="ChapterWrap Content" data-id="CJFD|FYYD201302002_h1_7"><h1 class="Chapter" data-id="CJFD|FYYD201302002_h1_7-H">七、转运的评估与质控</h1><p id="28" anchor="" data-id="CJFD|FYYD201302002_h1_7-P28">RNTN工作的顺利开展,以更好地保证转运质量,离不开正确的评估和质量控制管理<sup id="90" type="reference" href="41,71" rel="bibliography">[7,22]</sup>。应该指出,高危新生儿应积极通过宫内转运有计划的出生在有救治能力的III级NICU的医院里,如不能避免,通过专业新生儿转运队伍将高危新生儿转运至NICU以提高救治成功率就显得尤为重要。但转运队伍的每一位工作人员都应该清醒的认识到,转运危重新生儿是一个充满危险的过程,患儿随时都有恶化倾向。因此,RNTN系统必须以循证医学为基础,收集新生儿转运的资料,建立数据库,实施连续的专业转运培训和健全的风险报告机制,对转运质量定期进行评估并不断改进,以保证转运的质量和安全。</p></div></div></div></div></div><div class="references-box js-bottom-refer"><h3 class="ref-b-t">参考文献</h3><div data-v-10a8fdb6="" class=""><ul data-v-10a8fdb6="" class="note-list  refrence-list bottom-refrence-list"><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a data-v-10a8fdb6="" id="29" href="javascript:void(0)"><span data-v-10a8fdb6="">[1]封志纯.高危新生儿的转运.中国儿童保健杂志,2008,16:5-8.</span></a></span></li><li data-v-10a8fdb6="" title="" class=""><span data-v-10a8fdb6="" class="check-item"><a 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